Healthcare Provider Details

I. General information

NPI: 1811947419
Provider Name (Legal Business Name): KYLE JAMES JERAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 DOCTORS DR
GREENVILLE SC
29605-5608
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-7060
  • Fax: 864-797-7077
Mailing address:
  • Phone: 864-797-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number16620
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: